The Sanches Tapias TeraVIC Study 18 months vs. 12 months Also Clearing 4 weeks

This is the study that Dr. J. was talking about.  

In coordination with the BERG STUDY it seems to show that extending treatment to EIGHTEEN MONTHS (not a few extra random weeks as he said) improves your odds at SVR tremendously.

http://www.natap.org/2004/EASL/easl_06.htm
18 Months Therapy (Pegasys+Ribavirin): study found relapse rate reduced by 70%; viral response rate in genotype 1 increased by 50%

  
  "SUSTAINED VIROLOGICAL RESPONSE AFTER PROLONGED TREATMENT WITH PEGINTERFERON ALFA-2A (40KD) (PEGASYS

[amirtracy]

So. if you don't have a 4-week pcr (and i requested one but my dr. told me no since i was geno1) and a high initial viral load (i was 10mill) you should extend tx? i was UND @ week 12 & 24 and my enzymes normalized almost immediately and are now 16/15. this tx protocol changes so fast!

[NYgirl]

This study was done to show that those of us who are NOT UND at week 4 have a much better chance of SVR if we EXTEND treatment to 18 months.

So if you haven't cleared by week 4 but did AFTER THAT at any time...you might want to give it a read.

it is one of the deciding factors (along with BERG) that convinced me to GO for the 18 months (72 weeks vs. 48).

[NYgirl]

This strategy may be particularly important in patients with 'difficult-to-treat' characteristics, including those infected with genotype 1, high baseline viral load, previous nonresponders, and HIV-infected. The

I did NOT know it was harder for HIV infected to achieve SVR than just HCV infected, did anybody?  I wonder if they factor that in to the ENTIRE quotient of SVR rates for patients?

[Califia]

A girl's best friend is her cuppa java...gets those brain cells hoppin'.   (:

[Califia]

I am really glad to see you post this study, as it was the chief exhibit in my argument to my own hepatologist when I requested that he extend my treatment.   (A geno 1 with bridging fibrosis, I was not clear at 12 weeks, although I had exp'd a 3-log drop.  I was officially clear at 16.  My doctor was persuaded, after much lobbying on my part, to extend to 60 weeks, but he was leery of going the full 72.   I took what I could get.  I am expecting a one-year clear PCR in a couple weeks.)

I am writing to encourage everyone contemplating treatment, and anyone currently treating, to bite that bullet and wade into that nasty medical language until it becomes readable and even somewhat comprehensible.  Your own life depends on it.  There are a number of great sites out there--hivandhepatitis.com, hcvadvocate,org, Clinical Care, Projects in Knowledge-- that if read regularly could turn you into a research head par excellence and enable you to go toe to toe with _any_ doctor out there.  Please don't rely on one or two posters at Medhelp to do your homework for you.  Reading always involves analysis, and any one of us might interpret data differently than the next guy.  Final decisions rest with you and you alone.   Dare I say EMPOWERMENT?

At any rate, good work, NY!   And best of luck on this last stretch.

[cuteus]

excellent suggestion!
read and read again until you can see the light!

many a time I got a headache trying to understand one of those things! But it is imperative we read things ourselves and not a summarized, opinion laden comment of a particular abstract, glazed with "my dr said".

[Snookmiester]

Califia.....Hmm, pleasant suprise to see ya out of lurking!!

Sorry to butt in, but I wanted to add to thread below. Mikesimon brought up an excellent point about a thorough Dr exam.. As many have know, I have seen quite a few Dr's. None of them could feel my spleen while doing the physical exam, but all of which agreed that liver felt somewhat spongey, or stiff.
Upon examination by Schiff, the PA did not feel spleen, but as soon as he layed his hand down, he could feel it. He called the PA back in the room, and made her feel for my spleen. He actually showed her exactly what she did wrong, and said that it was a very common mistake, and easily overlooked.
Luckily for me, during my last visit he could not feel it, and he also said that liver had lost the stiffness he felt and noted in my charts prior..

[Califia]

Smart and battle tested.  I'm with you, I don't think there'll be any surprises at this point.   You'll find yourself grinding along, til it stops.  Or so I hope, at any rate!   It's really amazing how the body adjusts to life on the skanky bottom...

[DoubleDose]

What you stated above is exactly why I extended my tx, which ended about three years ago.  My doctor had been involved in quite a few studies with late responding type 1's, and had seen first hand the benefits of extending to 18 months, especially for responders clearing between 12 and 24 weeks.  The literature was scarce at that time, but my doctor had already seen the other studies, and watched his own patients.  I am certainly very happy that he was my doctor, and that I extended the full 18 months.  It provided me with the SVR, and was worth all the difficulty.  I had cleared at week 19, did have a 2-log+ drop at 12 weeks, and seemed an ideal candidate for the extended tx.
I also kept the inf. levels and riba levels at maximum, for just about the entire 18 months.

Good luck to you!!!  You made the right decision, I truly believe.

DoubleDose

[Kalio1]

I couldn't agree with all of you more, read read read and empower yourself. Califia your point that interpretation can vary is right on. Medhelp is great but you must take the time to do your own homework and dont take anyones word for anything without researching it and discussing it with your doctor. I know since the day I arrived here that has been Cuteus' mantra and I always listened to that good advice. Unfortuately for geno 2's and 3's there just isn't much available, if you are in the group that hasnt cleared or relapses or doesnt respond or hit a snag in some other way, it can be frustrating finding info. I look all over the world and Pakistan for info on Geno 3 there are lots of us there and also in Europe, Aussyland and Asia.

Much of the info is for geno 1 so if you are another geno you might have to dig ad stil not find any info at all. My doc will look at geno 1 info and consider it even though I am not that geno 1 because he says there just isnt much to go by.

[Califia]

One thing we do know now, thankfully, is that cirrhosis is reversible and that interferon is an effective antifibrotic.   Like everyone else here I was pretty distressed by your news, kalio, and I just want you to know that you've got the invisible minions plugging for you.  Just have faith that all your hard efforts will pay off.  Think of our tough little native plants, surviving in alkaline soils and surviving montlhs of drought, year in and year out.  We will survive to bloom again:  count on it.

[Kalio1]

Thank you for your eloquent words and support. What a great image to use, I will definately use that one being a native plant lover myself.

[NYgirl]

Very similar situation to my own, early 3log at 4 weeks then I got stuck with the last  400 suckers until somewhere btwn. 12 and 24.

There are many people who would like to just say "well my doctor said differently" but the chances are that the doctor ISNT always keeping up on the recent HCV studies (especially if they are a GI and not a heptologist or specialist) and they just don't KNOW.  They follow the protocol that you can currently read in ANY publication. That doesn't make it RIGHT just OLD.

I, just like you, don't want to do this all over AGAIN and have to do 72 on TOP of the first treatment of 48.  That = 120 weeks.

I'd much rather CONTINUE straight onwards (now that the sides have seriously abated due to time and rescues) and only do the 72.  The odds are SERIOUSLY lowered drastically when we do.

It's just sad that people aren't as completely obsessive as we are and don't do the work behind the disease.

I totally agree with you and Cuteus - read read learn study. That is the most IMPORTANT thing and what I was trying to explain in the thread below on doctors working for US.  Is it wrong if I've learned newer data than my doctor and present it to him?

Heck no.  It makes ME smart.

[sundancer2007]

So relapsers should figure on 72 weeks if they can get through. it.
I wonder what causes relapse. Hiding in pockets I have heard. But not sure. I don't think a relapser would want to risk only doing 48 weeks. Being  one of those "relapsers" the thought of 72 weeks seems daunting. I know others have done it. But after doing 48 weeks another 72 weeks seems like a real marathon which I need to start training for.

sd